Antianxiety Medications

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  1. Benzodiazephines
    Valium (diazepam)
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    • Side effects:
    • drowsiness, slurred speech, headache, mental confusion, disorientation, nystagmus, ataxia, agitation, sleep disturbances (changes in REM sleep), hangover, oversedation

    • Think alcohol, and don't use it. 
    • Most if not all can be habit forming.
    • Many sleep aids are benzo derivatives. 
    • Can cause cleft lip/pallet to fetus during 1st trimester. 
    • Cx for elderly with sundowners. May-->psychotic episodes. 

    Increases GABA released-->v cranial activity --> calmness.
  2. What do you need to monitor when pt is on benzos.
    • Monitor for oversedation side effects: slurred speech, sleeping, drowsiness.
    • Teach clients not to use alcohol which can potentiate the effects of valium. 
    • Increased risk for congenital anomalies in the 1st trimester.  Use with caution in women who become pregnant or who are pregnant.
    • It is excreted in breast milk and should be used with caution in nursing mothers. 
    • Do not take with MAO inhibitors
    • Antacids may delay the absorption.
    • Used with caution in the elderly.  Lower doses (one half to one third) should be
    •  considered.
    • Slow IV administration of benzodiazepines. Valium/diazepam = 1 mg./minute.
    • For IM administration, give deeply in muscle to eliminate irritation.
    • PRN administration is preferable to regularly scheduled doses because of the tendency for addiction to occur. Even a 6 month course of taking Xanax/alprazolam can cause difficulty when trying to get patients off. The agitation and anxiety prevent some from wanting to quit taking the medication.
    • Tapering is a safe way to discontinue because of risk for seizures.
  3. Benzodiazepine Antagonist (Flumazenil)
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    • Side Effects: Drowsiness
    • Use: Short-term management of anxiety and sleep
    • Action: Depresses subcortical centers. Has no dependence, tolerance or intoxication. Can be used for indefinite periods and with patients who abuse substances.
    • Nursing implications: Give Vistaril deep IM using Z-track method
  4. Non-benzodiazepine Antianxiety Agent:  Buspirone (BuSpar) 
    Be aware that another Rx has a very similar name.
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    • Side effects:  Headache, blurred vision, numbness, dizziness, excitement, feeling angry, nervousness, hostile behavior, nausea, and/or CHF.
    • Uses: Generalized anxiety disorders, can be used to treat anxiety in medically compromised clients such as those who have asthma or COPD.
    • Action:  Stimulates serotonin release from sending cells to synaptic clefts.
  5. Nursing implication of using buspirone?
    • Alleviates anxiety and does not appear to have an addition potential.
    • Requires 2 weeks to reach a therapeutic blood level. Teach clients to continue taking it and they may not feel better as soon.
    • Cannot eat grapefruit or drink grapefruit juice when taking buspirone.
  6. Beta Blockers for anxiety 
    Propranolol (Inderal)
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    • Side effects: Decreased sexual ability, drowsiness, difficulty sleeping, weakness, unusual tiredness.
    • Action: Blocks peripheral and central norepinephrine activity which blocks the fight or flight response.
    • Indications: Blood pressure must be high enough to take it.
    • Uses: Anxiety, GAD, PTSD, stage flight, migraine headaches
  7. Rx for OCD?
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    • Fluvoxamine (Luvox) SSRI (blocks the reuptake of serotonin) 
    • Side effects: Nausea, nervousness, drowsiness, insomnia, worsening of seizures

  8. Tryciclic antidepressants
    Mechanism of Action:  Its precise mechanism of action is unknown for OCD, but its ability to block the reuptake of serotonin (5-HT) is believed to be important.

    Anticholenergic effects = "No see, no pee, no spit, no shit."
Card Set:
Antianxiety Medications
2013-01-21 17:54:09

Mental Health
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